Modernising the NHS: the guru of the internal market warns against quick fixes

May 11, 2000

Modernising the NHS, A promising start, but fundamental reform is needed

The NHS has just been promised its largest sustained increase in resources since the service was started in 1948, with a national plan for health to be developed over the next two months by six action teams. The BMJ has invited six commentators to set out their priorities for each of the Prime Minister's modernisation action teams over the next few weeks. To kick off the series, Professor Alain Enthoven of Stanford University, who is widely credited as the driving force behind the creation of the NHS internal market, offers his views on the prime minister's plans for the NHS.

Professor Enthoven endorses the decision to pump more money in to the NHS but warns that the fundamental problems of the NHS cannot be fixed in time to make a noticeable difference before the next election. He argues that consumer choice, competition and strong incentives to modernise should all form part of the national plan.

Enthoven criticises the centralist approach adopted by Government, arguing that the centre does not invariably know best and that it will be seen as coercive and punitive. He argues that the Government was too quick to dismantle the internal market and that a centralised approach is incompatible with effective commissioning by primary care groups. He warns that the NHS lacks high quality clinical and financial databases and makes poor use of the information it has. Redressing this deficit must be a top priority and resources should be directed to reforms that will sustain large improvements over the long run.

Alain C Enthoven, Marriner S Eccles professor of public and private management, Graduate School of Business, Stanford CA 94305-5015, USA Email:


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